title: Elective percutaneous coronary intervention: the relationship between preprocedural blood glucose levels and periprocedural myocardial injury.
abstract: Regardless of the diabetic status of patients with coronary artery disease, hyperglycemia and hypoglycemia are adversely associated with cardiovascular events. The relationship between glucose levels and increased mortality risk in acute myocardial infarction has been shown through various glucose metrics; however, there is a dearth of multivariate analysis of the relationship between elective coronary angioplasty and preprocedural blood glucose levels. We evaluated the relationship between preprocedural blood glucose levels and myocardial injury in 1,012 consecutive patients who underwent elective percutaneous coronary angioplasty. The patients were classified into 4 glycemic groups on the basis of blood glucose levels measured immediately before the procedure: hypoglycemic, euglycemic, mildly hyperglycemic, and hyperglycemic. Samples for troponin I and creatine kinase-MB fraction were collected before each procedure and at 8, 16, and 24 hours after each procedure. Bivariate analysis revealed that postprocedural troponin I levels were significantly higher in the hyperglycemic group (P=0.027). Although postprocedural levels of creatine kinase-MB fraction rose insignificantly in the hypoglycemic patients, our results showed that these patients were more likely to have postprocedural levels 2 to 5 times the upper limit of normal (P=0.013). We tentatively conclude that abnormally low preprocedural plasma glucose levels-together with a recent history of smoking-are associated with an increased incidence of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention.
authors.affiliation: Departments of Cardiology (Drs. Abdi, Alizadeh, Firouzi, Madani, Salehi, and Shakerian), Physiology (Dr. Ghazaee), and Clinical Biochemistry (Dr. Zavarehee), Cardiovascular Intervention Research Center, Rajaei Cardiovascular Medical & Research Center; Tehran University of Medical Sciences, Tehran 1996911101, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Madani
authors.forename: Keivan
authors.initials: K
authors.lastname: Alizadeh
authors.forename: Sepideh Parchami
authors.initials: SP
authors.lastname: Ghazaee
authors.forename: Abbas
authors.initials: A
authors.lastname: Zavarehee
authors.forename: Seifollah
authors.initials: S
authors.lastname: Abdi
authors.forename: Farshad
authors.initials: F
authors.lastname: Shakerian
authors.forename: Negar
authors.initials: N
authors.lastname: Salehi
authors.forename: Ata
authors.initials: A
authors.lastname: Firouzi
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis*; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D007003:Hypoglycemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D019210:Troponin I; D052279:Creatine Kinase, MB Form
keywords: Biological markers/blood; blood glucose/analysis; coronary angioplasty/adverse effects; creatine kinase, MB form/blood; hyperglycemia/complications; hypoglycemia/complications; myocardial infarction; percutaneous coronary intervention/adverse effects; prospective studies; troponin I/blood